Apel D M, Marrero G, King J, Tolo V T, Bassett G S
Department of Orthopaedics, Children's Hospital of Los Angeles, California.
Spine (Phila Pa 1976). 1991 Aug;16(8 Suppl):S365-70.
Three patients paraplegic following anterior spinal fusion for congenital kyphoscoliosis were noted to have complete somatosensory evoked potential signal loss shortly after segmental arterial ligations at the apex of their respective kyphosis. This has prompted us to use temporary segmental arterial occlusion with somatosensory evoked potential monitoring prior to ligation during anterior spinal fusion. As a result, we have noted seven additional cases, out of a total of 44 cases monitored in this fashion, in which complete loss of somatosensory evoked potential signals, reversible by release of vascular clips, has occurred. For each of these additional cases the critical segmental arteries were identified and were not ligated, usually resulting in some modifications in the planned surgical procedure, and the patients remained neurologically intact. We recommend temporary segmental arterial occlusion with somatosensory evoked potential monitoring during thoracolumbar anterior spinal fusion to potentially avert ischemic neurologic injury. Based on published data and the experience described herein, this technique should be especially important in anterior spinal fusion for congenital kyphoscoliosis.
三名因先天性脊柱后凸畸形接受前路脊柱融合术后截瘫的患者，在其各自脊柱后凸顶点进行节段性动脉结扎后不久，体感诱发电位信号完全消失。这促使我们在进行前路脊柱融合术时，于结扎前采用体感诱发电位监测下的临时节段性动脉闭塞。结果，在以这种方式监测的总共44例病例中，我们又发现了7例，这些病例出现了体感诱发电位信号完全消失的情况，但通过松开血管夹可恢复。对于每一例新增病例，均确定了关键节段动脉且未予结扎，这通常会导致计划中的手术程序有所调整，而患者神经功能仍保持完整。我们建议在胸腰段前路脊柱融合术中采用体感诱发电位监测下的临时节段性动脉闭塞，以潜在地避免缺血性神经损伤。根据已发表的数据和本文所述经验，该技术在先天性脊柱后凸畸形的前路脊柱融合术中应尤为重要。
